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CPT 2023 Further Refines E/M Coding

CPT 2023 Further Refines E/M Coding

Changes to evaluation and management codes are going to take time getting used to.

CPT 2023 brings 225 new codes sprinkled throughout the code set, but it’s the revised and deleted codes in the Evaluation and Management (E/M) section you’ll want to pay the closest attention to. So, let’s start there in this quick review of the E/M code changes that go into effect Jan. 1, 2023.

Deleted CPT® 2023 Codes

To understand the revised evaluation and management (E/M) codes, we first have to look at what codes are deleted in that section of CPT® 2023. Hold on to your hats!

  • Under the Hospital Observation Services heading, observation care discharge services code 99217, initial observation care codes 99218-99220, and subsequent observation care codes 99224-99226 are deleted.
  • Under the Consultations heading, office consultation code 99241 and inpatient consultation code 99251 are deleted.
  • Other nursing facility services code 99318 is deleted.
  • Domiciliary, rest home, or home care plan oversight codes 99339 and 99340 are deleted, as are custodial care codes 99334-99337 for established patients and 99324-99328 for new patients in those settings.
  • Under the Home Services heading, the home visit code for new patients, 99343, is deleted.
  • Prolonged services add-on codes 99354-99357 are also deleted.

Update (March 2023): Hold claims for dates of service on or after Jan. 1, 2023, with codes 99354 and 99355, alerts Blue Cross Blue Shield of Michigan in The Record. “We’re working on identifying active codes that can be billed in place of the terminated codes,” the commercial payer said. Participating providers will be informed when to submit claims, and will be able to bill claims retroactive to Jan. 1, 2023.

There are also several Category III codes that are deleted for 2023. Services represented by these codes may have either graduated to become Category I codes or were deemed obsolete. Laparoscopy codes 49652-49657 are also deleted.

Revised CPT 2023 Codes

The removal of E/M observation codes, and others, required the American Medical Association (AMA) to revise the descriptors of several other codes in the E/M section. For example:

  • Under the Hospital Inpatient Services heading, initial hospital care codes 99221-99223, subsequent hospital care codes 99231-99233, observation or inpatient care services codes 99234-99236, and hospital discharge services codes 99238-99239 are revised to include “inpatient or observation care,” and
  • Office or other outpatient consultation codes 99242-99245 and inpatient consultation codes 99252-99255 are revised to include “office or other outpatient consultation.”

Revisions to other codes are in keeping with AMA’s guideline changes for E/M leveling using time or medical decision making (MDM). For example, the emergency department codes 99281-99285, initial and subsequent nursing facility care codes 99304-99310, and home services codes 99341-99342, 99344-99350 are revised to require a medically appropriate history “and/or” exam and MDM, instead of all three key components.

The nursing facility discharge codes 99315-99316 are revised to specify that the time must be “on the date of the encounter.”

The prolonged service code 99417 is revised to specify that this code is for an outpatient E/M, rather than an “office or other outpatient” E/M service. Of note: The part stating “on the date of the primary service” has been removed.

Also, in the E/M section, there are minor descriptor revisions to interprofessional telephone/internet/electronic health record consultation codes 99446-99449, 99451, cognitive assessment and care plan services code 99483, and transitional care management codes 99495-99496.

New CPT 2023 Codes

One last change in the E/M section: Whereas 99417 will now apply to prolonged services in the outpatient setting, new code 99418 will apply to inpatient or observation prolonged services (instead of 99356-99357).

In the Surgery section of CPT® 2023, there are new codes in several subsections. For example:

  • There are three new codes in the Integumentary subsection for implantation of absorbable mesh and removal of sutures.
  • The Musculoskeletal System subsection has only one new code for total disc arthroplasty.
  • In the Cardiovascular subsection, surgeons have five new codes for reporting percutaneous pulmonary artery revascularization by stent placement (33900-33904) and two new codes for reporting percutaneous arteriovenous fistula creation in the upper extremity (36836-36837).
  • Coders may feel they bit off more than they can chew after they dig into the 17 new codes in the Digestive subsection. The codes report esophagogastroduodenoscopy (43290-43291), repair of anterior abdominal hernias (49591-49618), repair of parastomal hernias (49621-49622), and removal of total or near total non-infected mesh or other prosthesis (49623).
  • The Male Genital System subsection sees only one new code: 55867 Laparoscopy, surgical prostatectomy, simple subtotal (including control of postoperative bleeding, vasectomy, meatotomy, urethral calibration and/or dilation, and internal urethrotomy), includes robotic assistance, when performed.
  • Coders won’t believe their ears when they find out there are only three new codes in the Auditory System subsection. CPT® codes 69729-69728 describe implantation, replacement, or removal of an osseointegrated implant.

In the Radiology section, there is one new code for diagnostic ultrasound, 76883 Ultrasound, nerve(s) and accompanying structures throughout their entire anatomic course in one extremity, comprehensive, including real-time cine imaging with image documentation, per extremity.

There is a lot more going on in the Pathology and Laboratory section with 11 new codes for various tests.

The Medicine section also received attention with 10 new codes for vaccines, special ophthalmological services, cardiac catheterization, quantitative pupillometry, multi-family group behavior management, and remote therapeutic monitoring.

Lastly, there is a collection of new Category III codes for reporting emerging technology, services, and procedures.

Learn More about CPT 2023

This, of course, is just the tip of the iceberg! Learn more about all these code changes, as well as changes to coding guidelines, in the 2023 CPT® Coding Update webinar with Raemarie Jimenez, CPC, CIC, CPB, CPMA, CPC-I, AAPC Approved Instructor, CCS, on Nov. 22, 10 a.m. PT/1 p.m. ET.

Renee Dustman
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Renee Dustman, BS, AAPC MACRA Proficient, is managing editor - content & editorial at AAPC. She holds a Bachelor of Science degree in Media Communications - Journalism. Renee has more than 30 years' experience in journalistic reporting, print production, graphic design, and content management. Follow her on Twitter @dustman_aapc.

17 Responses to “CPT 2023 Further Refines E/M Coding”

  1. Carolyn Roberts, CCS, CCS-P, CPC says:

    Hi Renee,

    Thank you for a great article.
    Re: CPT 55867 – Please correct the heading for the new prostatectomy code from the female genital system to the male genital system.

  2. Renee Dustman says:

    Thank you for bringing that to my attention, Carolyn!

  3. Kandi Arnhold says:

    Curious if you can address the deletion of CPT code 99354 that mental health therapists have been using more frequently for EMDR sessions. Is there any information what and if there is a CPT code that can be used by these providers who are nonphysicians and also do not bill E/M services?

  4. Renee Dustman says:

    Kandi: You may want to look at codes 99415, 99416, which are used when an E/M is provided in the office or outpatient setting to report the total duration of face-to-face time with the patient and/or family/caregiver spent by clinical staff on a given date.

  5. MaryAnn Luick says:

    Are there new 2023 CPT Codes for the CMS policies being finalized to pay for clinical psychologists and licensed clinical social workers to furnish integrated behavioral health care as part of a primary care team?

  6. Renee Dustman says:

    In the 2023 MPFS final rule, CMS finalized as proposed HCPCS Level II code G0323 Care management services for behavioral health conditions, at least 20 minutes of clinical psychologist or clinical social worker time, per calendar month … This code will be based on the current payment rate for GBHI CPT code 99484.
    RHCs and FQCHs bill G0511

  7. Lukas Swanson says:

    Has it been determined what will replace the ALF codes 99325-99328, 99334-99337 being deleted? Thanks.

  8. Renee Dustman says:

    Yes, 99324-99340 were deleted and merged with existing home visit CPT codes 99341-99350.

  9. Pam O'Connor says:

    So the Observation POS 22 remains the same? It is still considered outpt? If pt is in Observation status & a Consultation service is performed, we will still use 99242-99245, correct?

  10. Renee Dustman says:

    yes, POS is same as usual. and yes, consultation codes are the same, other than the removal of level 1. Of course, Medicare still doesn’t accept consultation codes.

  11. Robin Conners says:

    has the new MDM table come out?

  12. Renee Dustman says:

    Robin, It is in the 2023 code book, and you can download the new guidelines here: https://www.ama-assn.org/system/files/2023-e-m-descriptors-guidelines.pdf

  13. winnie says:

    With regard to the change in alf visits 99335 / 99326 are being deleted and apparently we are to switch to home cpt 99348 / 99344. however, place of service code for alf is 13 and home is 12. Claims are being denied for 99348 with place of service alf. can someone please explain how to bill for these alf visits and place of service approrpriate codes. CPT and POS

  14. Renee Dustman says:

    We will address your question in a future issue of Healthcare Business Monthly.

  15. Lisa says:

    To date, has there been replacement codes for 99354/99355 for licensed professional counselors?

  16. Renee Dustman says:

    CMS sates in the 2023 MPFS final rule, “CPT 99415 was created to describe the first hour of prolonged clinical staff services provided in addition to an office E/M visit, while CPT code 99416 was created to describe each additional 30 minutes beyond that first hour of prolonged clinical staff service time that was provided in addition to the O/O E/M visit.” CPT 2023 guidelines state “The physician or other qualified health care professional is present to provide direct supervision of the clinical staff.” CPT also indicates “99415 and 99416 are used to report the total duration of face-to-face time with the patient and/or family/caregiver …”

  17. Dimpy says:

    99291 is the bundle to all icu services